Individual
LA ROMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1640 WASHINGTON ST, BOSTON, MA 02118-3380
(617) 369-1577
(617) 369-1566
Mailing address
1640 WASHINGTON ST, BOSTON, MA 02118-3380
(617) 369-1577
(617) 369-1566
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1043336357
—
MA
Enumeration date
01/25/2019
Last updated
01/25/2019
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